Posterior tibialis tendon rupture concomitant with a closed medial malleolar fracture: A case report and literature review (original) (raw)
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Rupture of the tibialis posterior tendon in a closed ankle fracture: a case report
La Chirurgia Degli Organi Di Movimento, 2008
Rupture of the tibialis posterior tendon may occur during a trauma in pronation-external rotation of the foot or, less commonly, during a direct trauma of the ankle. When an isolated fracture of the medial malleolus is present, it is more likely that a direct trauma has occurred. A 36-year-old man with a non-displaced medial malleolar fracture was evaluated. Repair of the tendon and reduction of the fracture were performed. Twenty-four months after the operation, the fracture was completely healed, the patient was asymptomatic, he had a normal ankle range of motion, and the function and strength of the tibialis posterior tendon were equal to those on the contralateral side. Early surgical repair of the tibialis posterior tendon combined with malleolar fracture reduction is recommended to avoid progression to a plano-valgus foot.
The Journal of Foot and Ankle Surgery, 2015
Keywords: ankle fracture diagnosis flatfoot malleolus tibialis posterior tendon rupture a b s t r a c t Ankle fractures represent an exciting field of traumatology because of the wide variety of clinical presentations, injury mechanisms, and treatment options. Rupture of the posterior tibialis tendon (PTT) with ankle fracture can occur during trauma that involves pronation and external rotation of the foot or, less commonly, secondary to direct trauma to the ankle. This tendon injury is uncommon and probably misdiagnosed in many cases, because of the difficult clinical examination secondary to the pain and swelling. The identification and early treatment of PTT tears is essential for good functional outcomes to prevent the main mid-to long-term complication of disabling acquired flatfoot due to tendon failure. In the present report, we provide a review of the published data regarding ankle fractures associated with PTT rupture and describe our experience with a case of a multifragment medial malleolus fracture and complete rupture of the PTT diagnosed intraoperatively and surgically treated in a 34-year-old male, with 2.5 years of follow-up.
Tibialis posterior tendon injury associated with a closed medial malleolus fracture—a case report
Injury Extra, 2006
A 25-year-old healthy male solicitor was involved in a road traffic accident, being knocked off his motorbike by a car. He presented with an abrasion over the medial aspect of the right ankle and swelling of his right foot. The ankle was diffusely tender on the medial aspect and passive ankle movements were restricted and painful. There was no distal neurological deficit and posterior tibial and dorsalis pedis pulsations were palpable. Survey for associated skeletal injuries was negative.
Hong Kong Journal of Emergency Medicine
Introduction: Traumatic rupture of posterior tibialis tendon in association with medial malleolus fracture is extremely rare. Case Presentation: We demonstrate our experience in the management of a complete posterior tibialis tendon (PTT) rupture and anterior talofibular ligament avulsion fracture from the talus in association with medial malleolus fracture in a 30-year-old male motorcyclist without any open wounds. Discussion: We believe this to be the first reported injury of this type in the literature. Closed ankle fractures may obscure surrounding tendon rupture and the clinician may be tempted to focus on the osseous injuries rather than the significance of associated soft tissue injures. Conclusion: This particular case demonstrates the importance of assessing for PTT injury in situations where high velocity impact to the ankle results in malleolar fracture.
Tibialis Posterior Tendon Rupture Concomitant with Closed Bimalleolar Fracture
SAS Journal of Medicine
Introduction: Tibialis posterior rupture is rarely associated with ankle fractures, usually misdiagnosed, and leads to flatfoot deformity if untreated. Primary repair has been reported in most cases, with better outcomes regarding late deformity correction. Case Report: 22-years old female surgically treated for bimalleolar fracture, with intra-operative diagnosis of irreparable tibialis posterior tendon rupture, submitted to tenodesis to the flexor digitorum longus. Conclusion: Irreparable tibialis posterior rupture in acute fracture is a rare association with ankle fractures. Tenodesis to the flexor digitorum longus is a surgical option when primary repair is not possible.
Achilles Tendon Rupture with Isolated Medial Malleolar Fracture in Ipsilateral Ankle: A Case Report
Open Journal of Orthopedics, 2013
Achilles tendon ruptures and malleol fractures are commonly seen injuries in orthopaedic and traumatology practice, but what is rare is their concomitant. In this report, we aimed to present a rare case of a patient who has isolated medial malleolar fracture and achilles tendon rupture in ipsilateral ankle after an ankle sprain due to a fall from stairs and mechanism of injury.
The Management of Posterior Malleolus Fractures in Unstable Ankle Injuries: Where Do We Stand Now?
Cureus
The evaluation and treatment of the posterior malleolus fracture in unstable ankle injuries remain a topic of controversy. The main objective of this systematic review was to examine the available literature and identify the variables that affect the management of posterior malleolar fractures and how these are related to the outcomes. To that end, a systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of MEDLINE, Embase, and Cochrane Library was conducted. The search terms used were as follows: "posterior malleolar", "ankle fractures", "trimalleolar fractures", "ORIF", "surgery", "operative", and "conservative". The available studies were screened against the inclusion and exclusion criteria. Based on the review of the available literature, we have concluded that the size of the posterior malleolar fragment is not an accurate indicator, and clinicians should consider other factors such as fracture configuration and articular surface congruity. Also, the risk for the development of post-traumatic arthritis increases when the joint surface is not restored regardless of the surgical intervention and fragment size. The complications of posterior malleolus fractures necessitate evidence-based management. The assessment and the final treatment of these injuries in unstable ankle fractures should not be based on the traditional fragment-size parameters. Clinicians should assess the fracture configuration through imaging modalities and try to preserve the articular surface congruity so as to achieve optimal outcomes. Finally, more studies with high-level evidence are required in order to determine the most appropriate management pathway for these patients.
Journal of Foot & Ankle Surgery, 2010
Malleolar fractures are rarely associated with lesions of the adjacent tendons or neurovascular structures. The association of ankle fractures with Achilles tendon rupture is even more infrequent, although both of these injuries are very common in and of themselves. To our knowledge, fracture of the lateral malleolus in association with an acute rupture of the ipsilateral calcaneus tendon has not been previously described. In this article, we describe a female patient who sustained an acute rupture of the Achilles tendon in conjunction with fracture of the ipsilateral lateral malleolus.